This patient has a severe hypochloraemic metabolic alkalosis, with respiratory compensation. There is also a severe lactic acidosis (so there must be an additional component of a metabolic acidosis present) consistent with severe vomiting. Severe metabolic alkalosis – pH 7.68, … Continue reading →
There are still a few spots left on the Consultant Intensivist Transitioning (CIT) Course being held on Monday 25th to Tuesday 26th August 2014 at The Alfred in Melbourne, Australia. Originally designed and run by the brilliant Carole Foot, The Alfred ICU team are now the custodians of this course – however, the dynamic and engaging teachers that made it such a success are still at its core: Carole Foot, Liz Hickson and Kim Vidhani.
I did this course last year, and like many previous attendees found it to be a revelation. This course helps you take control of your career and ensure your future professional life is all that it can be. Topics covered – in an interactive, engaging and immersive format – include: conflict resolution, negotiation, non-technical skills, running meetings and dealing with politics, leadership, change management, managing performance, life planning, legal and ethical issues and more.
Furthermore, as a dual trainee, I have no doubt that other specialities such as emergency medicine and anaesthesia would get just as much out of the course as those working in intensive care.
Don’t miss out!
Disclosure: I know many of the people involved in this course personally and I work at The Alfred ICU.
27M h/o sickle cell anemia presents with high fevers, sweats, HA, muscle aches, N/V. Recent camping trip in New England. Blood smear shows the following:
What complications would you worry about?
Babesiosis is an infection caused by a malaria-like parasite, Babesia, a genus of protozoal piroplasms. Ticks may carry only Babesia or they may be infected with both Babesia and Lyme spirochetes. People can also get babesiosis from a contaminated blood transfusion.
Symptoms often start with a high fever and chills. Patients may develop fatigue, headache, drenching sweats, muscle aches, nausea, and vomiting. Babesiosis can be life-threatening to people with no spleen, the elderly, and people with weak immune systems.
Complications include severe hemolytic anemia, hypotension, liver problems, thrombocytopenia, and kidney failure.
Diagnosis: Blood smears may be examined under a microscope to try to identify the parasite inside red blood cells, however this method is reliable only in the first two weeks of the infection. “Maltese cross formation” as seen in the picture are diagnostic. PCR, FISH, and antibodies to Babesia may also be used.
Treatment: combination of 2 anti-parasitic drugs. Preferred regimen is atovaquone plus an erythromycin.
By: Virteeka Sinha* and Ameer Hassoun A teen came to the hospital complaining of testicular pain for the past few hours. I was the covering fellow. I examined the patient and documented a normal physical examination including the cremasteric reflex. I placed the Ultrasound probe and saw increased flow to the affected testis. I was happy I made the diagnosis right there and then! I went to my attending physician, a smart, experienced physician who has served as an expert witness in many litigations. I briefed him on my patient. What follows is a snapshot of that conversation: Me: I have a 16 y/o male with testicular pain, physical exam within normal, bedside Ultrasound (U/S) showed increased flow. It is likely epididymo-orchitis. Will give pain control and treat with antibiotics…. Attending: <interrupting> Wait .. Are you ordering an official U/S? Me: I see no need; clinically it is not torsion. Attending: I advise against that. We need to do the official U/S. Me: Why? Attending: You need some form of solid proof that it is not a torsion at this time, because if he walked out and he acquired a torsion you would be questioned in court. Does any one want to sit in the courtroom and answer why “something” was not done? Certainly not. Another perfect example is the use of GC/Chlamydia PCR versus cultures. Despite our knowledge that PCR is an accurate, quick method to make a diagnosis, we still have to do cultures for GC and Chlamydia. Why? Because the courts only recognize the results of the latter! Health care costs in the United States continue to be excessively high. National healthcare spending was at $2.8 trillion in 2012, representing expenditures of $8,915 for every person in the United States. Our nation spends 17.2% of its GDP on health care. Health care services, laboratory work up, admissions, evaluations, medications and health care wastes are major contributors. The one thing that is commonly overlooked in the context of health care reform is the looming threat of malpractice to which all physicians are subjected. In 2011, these restrictions reached a new level when Florida passed the “Physicians Gag Law,” a law that prevents physicians from asking families about firearm ownership. This bill included criminal penalties. To violate this law is a third-degree felony punishable by a fine of up to $5 million or a maximum of five years imprisonment. As a practicing pediatric emergency physician, too many of our decisions are influenced by legal rather than medical considerations. This makes it very challenging to practice medicine. We are cornered between “doing no harm” and a web of legal regulation. Extensive testing is a form of harm, as it can waste time, money and efforts on tests that carry with them the possibility of error. But we have to watch what we say, because a politician without a medical degree decided that questions we ask regularly to ensure a patient’s safety should be unlawful. In 2012, The New England Journal of Medicine published a study tackling medical malpractice across different specialties. The study revealed alarming numbers: 40% of claims were not associated with medical errors The claims not associated with medical errors accounted for 16% of total liability costs in the system 7.4% of physicians had a claim annually Pediatricians lead all specialties in the amount of malpractice payments (at an average of $520,000) despite such claims being only 3% of the overall number of claims Pediatricians in this era are overworked and poorly paid. These growing regulatory requirements further cripple their finances. When is this vicious cycle going to end? […]